Hospital Standardisation

Kai Tiaki : the journal of the nurses of New Zealand, Volume XV, Issue 2, 1 April 1922, Page 63

Hospital Standardisation

How hospital standardisation can improve the professional work and the service to the patient m the hospital, is explained m a report of a round-table conference on the subject, published m tint journal " Surgery, (xynecology, and Obstetrics/ of January, 1922. We rind the nursing section discussed m the quesirm: ' ' Can a hospital attain the minimum standard with what is considered an incompetent nursing staff?" The view given by Dr. Charles H. Mayo, whose name is so well known m many countries/ is of groat interest to all trained nurses. He says that modern methods, proved to be the best, are now accepted by the public. It is only a few decades since hospitals, some m truth hotbeds of infection, were looked upon as places to die in — as places of refuge, especially for the poor. They are now sought by the intelligent sick who desire the best possible care. That is true not only m America, where m the public hospitals there is special provision for private patients bein«- nursed m separate rooms by graduate nurses, but m this Dominion they enter the ordinary wards and are nursed, together with the igeneral cases, by probationer nurses under trained supervision. Dr. Mayo remarks that "the trained nurso has given the human, or shall we say the divine? touch, and made the hospital desirable for patients with serious ailments, regardless of their home advantages. The rich patient who can pay the price, the poor patient who can pay nothing, may secure the highest service m sickness. But how about the larger group of patients m the middle class, who are neither rich nor poor, and who would be glad to preserve their self-respect by paying m the limit of their ability?" This they can do m y?AV Zealand, by paying the full fee of a public hospital, but at the same time are still indebted to the surgeon or physician m whose charge they are. Dr. Mayo recommends, m order to provide a sufficient nursing service and to cope with the large proportion of trained nurses who fall out of the ranks chiefly

by marriage, that the foundation requirements of a nurse's training are too high for the average demand, and that, m all fairness, they should be made a little highll' by specialisation, so that for ordinary iiursing duty a greater number may obtain the advantage of training. He considers that the course of training should be two years, with post-graduate study for the third year, which should be optional, and that it should be possible to take it at any time desired, so that those who remain m the work may fit themselves for the work m which there is greater opportunity for service and securing personal distinction. Dr. Mayo remarks that nurses who are compelled to study and labour diligently for three years, after having achieved a high standard of general education, are overtrained for nurses and undertrained for physicians. There is no doubt that many girls may attain m two years, provided they have made full use of their opportunities and have not been taxed too heavily m duties for the hospital which scarcely come under the heading of nursing, a sufficient knowledge and facility m nursing procedure to carry on quite well the care of patients under supervision. The making of full use of opportunities, however, would not be compatible with the eight hours system of duty, as well as one day off per week, which it is at present the aim of New Zealand hospitals to igive, and the use of these long periods of leisure m mere amusement and recreation. Some of these hours of leave from ward work would have to be utilised m study, m attending lectures, m watching operations, m observation of special cases, and so on. We rather advocate, however, the ordinary three-year course as the minimum requirement, and a fourth year for specialisation. We recommend nurses, after becoming qualified by State examination, to remain for a further period m their train-ing-schools, provided opportunity is given them — which is not always the case — for extra-special experience m any branch of

nursing they desire to take up. If they do not desire to specialise, but to carry on as private nurses, and if during this fourth year some special advantages are not offered them, then .they are wise to leave their hospitals and thus provide a vacancy for another trainee. While reading with great interest all that Dr. Charles Mayo has advanced m the article referred to, we entirely disagree with his proposal m another paper, that the remedy for the expense and shortage of nurses is the training of sub-nurses, or nursing aids. His reason for this suggestion is that the trained nurse's charge is ''exorbitant or more than exorbitant — it is prohibitive;" but, as our contemporary "Una" remarks, there are two sides to that question, and it is hardly fair to expect nurses to do for little or nothing what the doctor is able to do only because he can make his rich clients pay for the poor ones. That the nurses cannot do, as their time is usually occupied with one case. We do not consider that partlytrained women could take the place of trained nurses m this Do-

minion, and there would be great danger of an ignorant public accepting any sort Df training; thus the standard of the profession of nursing would be jeopardised. Prom the fact that- many American nurses of high standing advocate the training of nursing aids, it is possible that conditions m America may justify such a step. A further quotation from the same section of the journal quoted is: "The greatest need m the suffering world to-day is for young women of good breeding, of good education, and of fixed principles of righteousness, which, when added to good training, will make an army which will be invincible before selfishness, negligence, and profiteering. " This is not likely to be attained by making two ranks or classes of nurses. Who is to differentiate as to when a real nurse is needed or a mere partly-trained substitute? No; let every woman who wishes to enter the profession make up her mind to take at least the minimum course for qualification, and add to that experience and specialisation m different branches.